opiates

The implementation of medical marijuana programs is associated with a decrease in the prevalence of opioids detected among fatally injured drivers, according to data published in the American Journal of Public Health.

Researchers at Columbia University in New York and the University of California at Davis performed a between-state comparison of opioid positivity rates in fatal car accidents in 18 states. Authors reported that drivers between the ages of 21 and 40 who resided in states that permitted medical marijuana use were approximately half as likely to test positive for opioids as were similar drivers in jurisdictions that did not such programs in place.

They concluded, “Operational MMLs (medical marijuana laws) are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.”

Prior comparisons have determined that medical cannabis access is associated with lower rates of opioid use, abuse, and mortality. Most recently, a 2016 study published in the journal Health Affairs reported a significant decrease in the use of prescription medications following the implementation of medical marijuana programs.

An abstract of the study, “State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers,” appears online here.

Rising rates of medical cannabis use among Canadian military veterans is associated with a parallel decline in the use of prescription opiates and benzodiazepenes, according to federal data recently provided to The Globe and Mail.

According to records provided by Veterans Affairs Canada, the number of veterans prescribed benzodiazepines (e.g. Xanax, Ativan, and Valium) fell nearly 30 percent between 2012 and 2016, while veterans’ use of prescription opiates declined almost 17 percent. During this same period, veterans seeking federal reimbursements for prescription cannabis rose from fewer than 100 total patients to more than 1,700.

Canadian officials legalized the use of cannabis via prescription in 2001.

Prior assessments from the United States report that incidences of opioid-related addiction, abuse, and mortality are significantly lower in jurisdictions that permit medicinal cannabis access as compared to those states that do not.

Investigators assessed anonymous prescription reporting data from over one million employees between the years 2011 and 2015.

In states that did not permit medical marijuana access, 5.4 percent of individuals with an opioid prescription qualified as abusers of the drug. (The study’s authors defined “abuse” as opioid use by an individual who was not receiving palliative care, who received greater than a 90-day cumulative supply of opioids, and received an opioid prescription from four or more providers.) By contrast, only 2.8 percent of individuals with an opioid prescription living in medical marijuana states met the criteria.

The findings are similar to those reported by the RAND Corporation in 2015, which determined, “[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.”

Data published in 2014 in the Journal of the American Medical Association (JAMA) Internal Medicine also reported that the enactment of statewide medicinal marijuana laws is associated with significantly lower state-level opioid overdose mortality rates, finding, “States with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.”

Full text of the new study, “The opioid crisis in America’s workforce,” appears online here.

Cannabis use is associated with improved outcomes in opioid-dependent subjects undergoing outpatient treatment, according to data published online ahead of print in the journal Drug and Alcohol Dependence.

Researchers at Columbia University assessed the use of cannabinoids versus placebo in opioid-dependent subjects undergoing in-patient detoxification and outpatient treatment with naltrexone, an opiate receptor antagonist. Investigators reported that the administration of oral THC (dronabinol) during the detoxification process lowered the severity of subjects’ withdrawal symptoms compared to placebo, but that these effects did not persist over the entire course of treatment. By contrast, patients who consumed herbal cannabis during the outpatient treatment phase were more readily able to sleep, were less anxious, and were more likely to complete their treatment as compared to those subjects who did not.

“One of the interesting study findings was the observed beneficial effect of marijuana smoking on treatment retention,” authors concluded. “Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo.”

The findings replicate those of two prior studies, one from 2001 and another from 2009, reporting greater treatment adherence among subjects who consumed cannabis intermittently during outpatient therapy.

Population data from states where medicinal cannabis is permitted report lower rates of opioid-abuse and mortality as compared to those states where the plant is prohibited. Clinical data and case reports also indicate that the adjunctive use of cannabis may wean patients from opiates while successfully managing their pain. Survey data of state qualified medical cannabis patients demonstrates that subjects with access to the plant often substitute it for opioids because they perceive it to possess fewer adverse side effects.

Overdose deaths involving opioids have increased dramatically in recent years. While fewer than 4,100 opiate-induced fatalities were reported for the year 1999, by 2010 this figure rose to over 16,600 according to an analysis by the US Centers for Disease Control.

An abstract of the study, “The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone,” appears online here.

Researchers from the RAND Corporation and the University of California, Irvine assessed the impact of medical marijuana laws on problematic opioid use, as measured by treatment admissions for opioid pain reliever addiction (compiled from the years 1992 to 2012) and by state-level opioid overdose deaths (compiled from the years 1999 to 2013).

“[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not,” authors reported. They found that women over the age of 40 showed the most significant decrease in problematic opioid use.

Data published last year in the Journal of the American Medical Association (JAMA) Internal Medicinereported that the enactment of statewide medicinal marijuana laws is associated with significantly lower state-level opioid overdose mortality rates. “States with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws,” investigators reported.

Overdose deaths involving opioid analgesics have increased dramatically over the past decade. While fewer than 4,100 opiate-induced fatalities were reported for the year 1999, by 2010 this figure rose to over 16,600 according to an analysis by the US Centers for Disease Control.

An abstract of the study, “Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?”, is available online here.